Psychiatry - D - Substance Related Disorders

Front 1

prevalence of alcohol abuse? alcohol dependence? illicit substance use?

Back 1

alcohol abuse: 20% males, 10% females

alcohol dependence: 10% males, 5% females

20% lifetime prevalence of illicit substance abuse

40% of ppl use 1 or more illicit substances in their lifetime

15% of ppl used in past year

Front 2

cost of addiction in US?

Back 2

etoh alone - $300 billion / yr

13 million americans req tx for alcohol abuse

5.5 million americans (27% population > 12 yo) req tx for drug use

Front 3

% of hospitalization w/etoh as factor?

Back 3

40%

Front 4

% of all hospital deaths involving etoh?

Back 4

25%

Front 5

# deaths/yr from drug/etoh?

Back 5

100,000

Front 6

% MVAs, DV, & murders etoh is associated with?

Back 6

50%

Front 7

substance abuse criteria?

Back 7

maladaptive pattern substance use leading to sig. impairment/distress, manifested by 1+:

-failure to fulfill role obligations / poor work
-use on hazardous situations
-substance related legal problems
-persistent/recurrent social/interpersonal problems

never met criteria for dependence

Front 8

substance dependence criteria?

Back 8

maladaptive pattern substance use lead to clinical sig impairement/distress, w/3+ occuring at any time w/in same 12 mos period:

1. Tolerance
2. Withdrawal
3. Substance taken in larger amnt or for longer than intended
4. unsuccessful attempts to cut down
5. great amnt time spent obtaining, using, or recovering
6. important social, occupational, recreational activities given up/reduced
7. use continued despite knowledge that has persistent/recurrent physical/psychological problems

Front 9

substance dependence course specifiers?

Back 9

early remission - no criteria for > 1 mos, < 12 mos

sustained remission - no criteria for > 12 mos

partial remission - occasional criteria met

full remission - no criteria met

Front 10

dependence - learning & physiologic basis - circuits?

Back 10

hippocampal and limbic memory circuit, reward circuit, pleasure circuit, reinforcing behaviors

ex: increased dopamine in limbic areas (ventral tegmental DA neurons synapsing on nucleus accumbens neurons is very rewarding)

Front 11

what % pts are eventually able to abstain or decrease use to not meet criteria for dependence/abuse?

Back 11

70%

Front 12

sx of alcohol withdrawal? how long for risk seizures / DTs?

Back 12

HTN, tachycardia, diaphoresis
cofnusion, alternating loc, hallucinations, vascular collapse

seizuries 48-72 hrs

DTs usually appear w/in 72 hrs

Front 13

alcohol w/d tx w/risk of seizure?

Back 13

use anticonvulsants (carbamazepine or valproic acid) for at least 3 wks

Front 14

medication for alcohol tx?

Back 14

disulfuram - inhibit aldehyde dehydrogenase
check LFTs and h/o hep C

naltrexone - opioid antagonist
-hepatotoxicity at high doses so check LFTs

acamprosate - unknown MOA, thot to stabilize neuron excitation and inhibition
-may interact w/GABA and Glu receptor
-renally cleared

Front 15

benzodiazepine taper?

Back 15

reduce dose every 1-2 wks, no more than 5 mg diazepam equiv

may consider carbamazepine or valproic acid if doing rapid taper

Front 16

benzo half lives?

Back 16

alprazolam: 6-20h
oxazepam: 8-12h
temazepam: 8-20h
Clonazepam: 18-50h
Lorazepam: 10-20h
chlordiazepoxide: 30-100h

Front 17

benzos metabolized thru only glucoronidation in liver? (not affected by age/hepatic insufficiency)

Back 17

oxazepam
temazepam
lorazepam

Front 18

neuroadaptation in opioids?

Back 18

increased DA and decreased NE

Front 19

tx of opoid dependence?

Back 19

naltrexone - opiate blocker, mu antagonist

methadone for substitution therapy, titrate up until not craving or using illicit opioids

buprenorphine - parial mu agonist/antagonist
-low doses: agnoist w/pain control
high dose: no increased effect, maybe antagonist

any physician can rx after certified ASAM course

Front 20

tx of stimulants?

Back 20

rest and support

Front 21

cocaine - medical risks? neuroadaptation?

Back 21

vasoconstrictive effects - increased risk CVA and MI (obatin EKG)

neuroadaptation - prevent reuptake of DA

Front 22

amphetamine neuroadaptation?

Back 22

inhibit reuptake of DA, NE, SE

greatest effect by increased release DA

Front 23

amphetamine tx?

Back 23

no specific meds

promising research w/atypical antipsychotics

Front 24

nicotine - % of US deaths? % smokers dying from related d/o?

Back 24

20% of all US deaths

-25% current smokers, 25% ex smokers

45% smokes die of tobacco induced disorder

schizophrenia - 75-90% smoke

Front 25

MDMA - tolerance? duration of action?

Back 25

3-6h

tolerance develops quickly, unpelasant side effect w/continued use (teeth grinding)

Front 26

MDMA neuroadaptation?

Back 26

affects serotonin, DA, NE, predominantly 5HT2 receptor agonists

Front 27

cannabis - pk levels? half life?

Back 27

peaks 10-30 min

half life = 50h

Front 28

cannabis neuroadaptation?

Back 28

decrease uptake of GABA and DA

G prtns and adenylate cyclase - Ca channel inhibiting Ca influx

Front 29

PCP sx, tx?

Back 29

sx - cerebellar sx - nystagmus (vertical)
-catatonic, mute, mm rgidity, hyperthermia, rhabdo

tx - antipsychotic drugs or benzos if needed

acidify the urine w/IV ammonium chloride if severe toxicity/coma

Front 30

PCP neuroadaptation?

Back 30

opiate receptor effects

allosteric modulator of glutamate NMDA

no tolerance of withdrawal